Clinical Ophthalmology (Oct 2018)
Cost analysis of vitrectomy under local versus general anesthesia in a developing country
Abstract
Gilbert WS Simanjuntak,1–3 Ari Djatikusumo,4 Asri Adisasmita,5 Mardiati Nadjib,6 HHB Mailangkay,1 Nazimul Hussain7 1Department of Ophthalmology, Faculty of Medicine, Christian University of Indonesia, Jakarta, Indonesia; 2Cikini Eye Institute/Cikini CCI Hospital, Jakarta, Indonesia; 3Cikini Eye Institute, Jakarta, Indonesia; 4Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 5Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia; 6Department of Health Policy Administration, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia; 7Department of Ophthalmology, Mediclinic Parkview Hospital, Dubai, UAE Purpose: To report cost reductions of vitrectomy under local anesthesia.Patients and methods: This was a retrospective cohort study using medical records of consecutive patients undergoing vitrectomy surgery for retinal detachment under general or local anesthesia. Data of patient’s fulfilling the inclusion criteria were included in the study. The patients were divided into two groups: Group 1 (local anesthesia) and Group 2 (general anesthesia). The preoperative data were checked and validated by a peer group consisting of two ophthalmologists, two internists, and two anesthesiologists independently in a blind manner. The calculation of the cost was done using the cost minimization analysis. The cost data were obtained from the finance division of the hospital for each individual treatment. The cost data included unit cost of laboratory tests, surgery, and medications.Result: There were 100 subjects (50 subjects in each group) assessed by peer groups and declared eligible to undergo surgery under either local or general anesthesia. Both groups were equal. The total average cost for vitreous surgery under general anesthesia for each patient was $322.17, whereas for local anesthesia it was $220.57. The mean difference was $101.60 (46.06%) saving on local anesthesia.Conclusion: Vitrectomy surgery under local anesthesia can reduce the cost by almost half that of general anesthesia. The present study showed that the type of anesthesia determined the ultimate cost for the surgery. Hence, surgery under local anesthesia appears affordable and cost-effective, especially in a developing country like Indonesia. Keywords: cost analysis, anesthesia, vitrectomy, retinal detachment, cost minimization
